Posted tagged ‘child’

S.A. asked, “What kind of discipline strategy can I use to get my daughter to stop picking at scabs. She’s three years old, and she has a lot of scars already.”

I don’t think a traditional “discipline strategy” is really what you’re looking for—at least no one based on rules. You shouldn’t “forbid” the picking, or make a rule that says “No Picking,” because you won’t be able to enforce that kind of rule. For young children, it’s important that any rule you make is 100% enforceable, all of the time. That’s the best way for children to learn that rules are rules, and rules can’t be broken. If you make a “don’t pick” rule, as soon as you turn your back the picking will resume. So what your daughter will learn is “I don’t have to follow rules when mom isn’t watching.” And she’ll still be picking!

Instead of trying to forbid the picking, try distraction instead. When you see picking, give your daughter a toy, or suggest something else to do. Something that’s new or different is more likely to get her attention, and a game with mom is always fun.

You can also make a positive reinforcement chart. You can work out the details, but you could start with something like: If a day goes by without picking, she gets one sticker. Three stickers earns a trip to the dollar store; six stickers ears a trip out for ice cream.

Once wounds heal, they won’t attract picky fingers. Help minor skin wounds heal faster by washing them gently every day with soapy water. Afterwards, rinse, dry, put on a dab of antibiotic ointment (like Polysporin), and cover it with an adhesive bandage. Colorful or cartoony Bandaids might be more likely to discourage picking. If any of the sores are draining, painful, or spreading, take her to her doctor.

Though picking can make sores and scabs more prominent, and can learn to dark spots, it’s rare for these spots to be permanent. They may take a while to fade, but superficial sores, even picked-at ones, rarely leave any permanent marks. If your child is truly digging at these things aggressively and constantly, talk with her doctor to make sure that there isn’t a more-serious developmental issue going on.

BB has mixed feelings about getting her daughter’s ears pierced: “What are your thoughts on the safety of piercing a baby or toddler’s ears? I’ve read mixed info about the ‘best’ age to pierce a young girl’s ears. I’d like to know what pediatricians typically recommend. I know this isn’t likely a pressing medical issue, but I want to make a safe, wise, informed choice for my daughter.”

Early or later piercing are both safe, so it’s mostly just a matter of family choice. Some families prefer to pierce early, before a baby could remember it; others want to let a child decide for herself when to do it. Some people like to pierce ears even in the newborn period, and I’ve never seen or heard of any sort of important complication from early piercing.

In fact, the few complications I have seen have been in teenagers rather than babies. Teens aren’t always as good about keeping new piercings clean (new piercings are far more likely to get infected than old, established holes.) I’ve seen a few teens (boys, naturally) ignore their posts completely, so skin grows over the front or the back. Also, teens are more likely than young children to develop keloid scars after piercing.

Whenever you do pierce, follow the instructions on keeping the area clean and using an antiseptic solution. It’s best to do the first pierce with good gold posts, and leave them in for a long while; don’t swap them over to little skinny loops until the hole is mature. The backing should never be tight against the back of the ear—leave a little wiggling for growth and to allow good air and blood circulation. Though the backing shouldn’t be tight against the ear, it does need to be tight on the post to keep the earring in the ear and out of a young child’s mouth. If there are signs of infection like increasing pain, warmth, redness, swelling, or drainage, go see your doctor.

Every once in a while, I get asked about doing ear piercing in my office. I’m not so sure that’s a great idea. Personally, for my own daughters, I’d rather have a piercer who does these all day, every day.

What about piercing other body parts? Holes through ear cartilage are somewhat more likely to get infected, and those infections can be more difficult to treat. Still, they’re usually fine. Lips and noses and eyebrows don’t seem to lead to many problems. However, tongue pierces can increase the risk of some very serious infections—like brain abscesses—and can cause speech problems and broken teeth. As for more exotic piercings south of the mouth—I don’t even want to know.

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Here’s a request from Rhonda: “I was wondering if you could post something about negativity in children. I am sure I can’t be the only parent dealing with a child who can’t help himself from constantly complaining and using negative talk all day long. It’s exhausting to live with someone who sees the glass as always half empty.”

Negativity is a behavioral “rut”—a way of looking at things or doing things that tends to reinforce itself over time. If you or your child acts negative and says negative things often enough, soon you’ll find that a negative outlook is the “automatic” response.

I’ve written about one good approach to getting out of a negative rut before, a method I call “The Greenies.” That works best for ages 3-7 or so, and can be a great way to develop positive habits for both parents and children.

Also, look at your own way of communicating. Are you saying “no” a lot to your child? Parents of toddlers probably say no hundreds of times a day, and kids will pick up on that and begin to imitate it. If your response is usually “no”, your child will get very used to saying that, too.

You want to teach toddlers to communicate without whining and begging. A great way to do this is to train yourself to try to always say yes to any safe request—IF it’s asked in a reasonably nice way. What constitutes “nice” depends on the age—a friendly-sounding point and grunt is pretty nice for a 13 month old, but you ought to require a four-year-old to say “please”. Silly requests are fine (as long as they’re safe). This is a great age for kids to go to The Home Depot dressed as Bob the Builder, or draw on the walls of the shower with pudding or shaving cream. On the other hand, you must ignore any request that isn’t asked nicely. Whining, cajoling, begging, repeating, tugging, nagging—all of that gets, well, nothing.

Ask multiple-choice questions rather than yes/no questions. Instead of saying “Do you want to wear the red shirt?”, ask “Do you want the red or the blue shirt today?” Too many choices can be overwhelming, and you shouldn’t pepper your child with questions all day long, but try to phrase the questions you do ask in a way that makes “no” not an answer.

There may be particular times when negativity is strongest. Children may be more likely to act whiney when they’re hungry, or tired. It may be best to “steer clear” of your child during those rough times, to give him a chance to sort it out. You can also offer some affirmation and sympathy–“I know it’s hard to smile when you first get up. I’ve got breakfast ready for you when you’re feeling up to coming downstairs.” Don’t expect the best behavior all of the time.

When your child does whine and complain, you ought to ignore it. Don’t argue or try to talk him out of his negative mood. The interaction with you will reinforce negativity. Even a punishment is at least some interaction with mom, and that’s what kids crave. Instead, look for times when your child is positive (or at least vaguely less negative), and make sure to pay plenty of attention to him then. Reflect a positive attitude back, and you’ll get more of that positive attitude in the future.

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Language skills are fundamental to success, and speech skills learned in early childhood are strongly associated with later cognitive development. There are many products available that claim to give a child a “leg up” on learning—special videos, interactive toys, flashcards—but a recent study supports an old notion that the best way to help your children learn to speak is to simply talk with them.

In the 2009 study, published in Pediatrics, researchers used small digital recorders worn by about 275 children to determine how many words they heard each day, how much television they listened to, and how many interactive conversations they had with adults in their lives. They also measured each child’s language performance. On average, the children in the study heard about 13,000 words each day.

The number of words spoken to the child was strongly associated with improved language skills, but an even stronger effect was seen with conversational turns—that is, the number of times adults spoke with the child, taking turns in a conversation. Television was a negative predictor of language skills. More time listening to TV correlated with fewer conversations, and poorer speech development.

Speaking to your child is good; speaking with your child is better. Tell stories, interrupt yourself for questions, and allow your child to make up the next few sentences. Encourage back-and-forth conversations. Give your child time to think and respond, and show with body language and patience that you want her to ask questions back. You’ll get some laughs, you’ll learn about your child’s world, and you’ll help your child grow.

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Gretchen has a behavior quandary: “My 3 1/2 year old is suddenly having major behavior problems and is really wreaking havoc on the household. She is whining, hitting, calling everyone ‘bad’ and has started ‘hating’ everything and everyone. I’m sure this is just one of her many phases and is probably worsened by summer boredom but do you have any ideas as to how we can minimize the frustration? I feel like I am constantly yelling and punishing.”

We all have behavioral “ruts”—patterns of doing things that we end up doing over and over, soon enough becoming habits. It’s easy to make a rut, and easy to stay in a rut. Some ruts might even be a good thing, like a toddler learning to clear his plate or put his toys away. But other ruts can be aggravating, like Gretchen’s example. It sounds like the child is in a new negative rut, and mom has formed her own rut of “constantly yelling and punishing.”

It’s time for a new plan: The Greenies!

This is a method of discipline that relies on positive reinforcement. It’s especially useful to break a cycle with a child who is “constantly” disruptive or disrespectful, and is most suitable for ages 3-7 or so.

Every adult in the house should carry a washable green magic marker with them at all times.

Catch your child being good at least once every ten minutes.

Give immediate feedback that is specific:

Good: “Thanks for helping!”

Better: “It’s great when you get yourself ready.”

Better: “That was great when you helped by putting your own shoes on. Thanks!”

Along with your verbal praise, use your green marker to make a quick dash on the back of the child’s hand.

Within a few hours, there will be many dashes.

At the end of the day, the backs of your child’s hands should be covered with green marks.

At bedtime, go over some of the marks—point to one or two, and say things like “Remember that one? That was when you kissed grandma! And this one here—this one was when you put your dinosaur toy away!” Again, your praise should be as specific as possible.

This is a method only for positive reinforcement. There are no punishments, and the child cannot “lose” any green marks. It builds only on positive praise.

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In prior posts, we’ve covered what a fever is, and why the body runs a fever, and how to tell if a fever is something serious to worry about. Putting all of this together in one practical plan has been the goal of this series. We want to keep children healthy and safe, and avoid unnecessary Emergency Room visits—while looking out for occasions when a child might really need evaluation right away. So here it is, what you’ve been waiting for, The Pediatric Insider fever “action plan.” Clip and save, or even better, share this with friends to bring more eyeballs to my blog. You found it here first!

What to do if your child feels like he has a fever

1. If your child looks very ill—he’s unresponsive, having trouble breathing, or has a blue or grayish color—call 911 or bring him to the nearest emergency room.

2. If the child has not reached his four month birthday, measure the fever with a thermometer, rectally. If the number is 100.4 F or higher, call your child’s pediatrician for instructions. Fevers in very young babies are far more likely to be caused by a serious problem, and usually need to be evaluated right away. Even if the measured temperature doesn’t show that your baby has a fever, call your pediatrician if your child seems unwell.

3. If your child has a poor or abnormal immune system, or has a disease that you’ve been told predisposes to serious infections, call your physician. You should also contact your physician if your child has a fever and has not been immunized—these kids are at much higher risk for serious bacterial infections that may need urgent evaluation and therapy.

The remainder of this action plan is only for normal, otherwise healthy and immunized children 4 months of age or older.

4. (Optional) Measure the temperature in an appropriate way with a thermometer. There is no reason to check a rectal temperature on an older child. An axillary (armpit) or temporal artery temperature is a good enough estimate. (I haven’t found ear thermometers, pacifier thermometers, or skin thermometer strips to be accurate) If you don’t have a thermometer handy, it is not essential to measure the temperature; but it can be handy for monitoring to keep track of the temperature trend, especially if the fever lasts more than a day.

5. If you child feels ill (achy, or just “blah”), give a dose of fever-reducing medicine such as acetaminophen or ibuprofen. You’re giving the medicine to help your child feel better—not necessarily to reduce the fever—but it will probably help the fever drop, too.

6. After the fever decreases, see how your child feels. If he’s still feeling ill, contact your physician for instructions or bring him to the doctor. If he’s looking and feeling better, see how he’s doing in the morning and call your pediatrician for a non-emergency appointment within a few days for evaluation if the fever or other symptoms persist.

Fever itself can be an unpleasant symptom, often accompanied by chills and aches. Parents should treat fever with medicine not because the fever itself is harmful, but to help the child feel better. Even if the fever medicine doesn’t reduce the temperature back to normal, it will help how your child feels. It’s also easier and more accurate to judge just how sick a child is after the fever has been brought down.

During a fever, you’ll also want to offer your child extra fluids. It doesn’t matter what Junior drinks, as long as it’s wet. Milk and other dairy products are fine during a fever (even an extremely high fever isn’t nearly warm enough to “curdle” milk.) Jello, applesauce, pudding, ice cream, and Popsicles are all also good choices. For little babies, encourage frequent nursing or offer an extra bottle. If your child doesn’t feel like eating, that’s OK—as long as he’s drinking, he won’t get dehydrated.

“Fever phobia” is an unwarranted fear that fever is really going to harm your child. In the past, fevers could often have been a harbinger of a truly devastating illness. Nowadays, almost all of the serious fever illness are easily prevented with vaccines and simple hygiene. The few serious fever illnesses that still occur are far more easily recognized and managed. Though fever ought to be treated if it makes your child feel bad, it’s nothing to be afraid of. Protect your child with vaccines, look out for the few red flags that we’ve discussed, and help your child stay comfortable when the occasional fever strikes.

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This site is for informational purposes only. Communicating via this board does NOT create a doctor-patient relationship. If you have a medical concern specific to your child, contact your own pediatrician.

Unauthorized use and/or duplication of this material without written permission from the blog owner is prohibited. Excerpts and links may be used, provided that full and clear credit is given to Roy Benaroch, MD and www.PediatricInsider.com with appropriate and specific direction to the original content.